GUIDE TO PATHOLOGY TESTS - Clinical Labs

1 ABDOMINAL PAIN Baseline: ECU, LFT, CRP, cTn, Lipase, Amylase, HCG, FBE, urine MCS Additional: Calcium, Phosphate, Lactate, Blood Gas, faeces (MCS, OCP, PCR), Urine Porphobilinogen Supplementary: Blood Culture, H. Pylori Faecal Antigen Test, Urea Breath TestADRENOCORTICAL FUNCTION Addison s disease Baseline: S-Cortisol, ACTH, ECU Additional: Synacthen stimulation test. Supplementary: Adrenal-Ab, thyroid-Ab, ovarian-Ab, Tuberculosis, septicaemia, HIV, 17-OHP, VLCFA, Fine Needle Biopsy Cushing syndrome Baseline: 3 x 24 hour urinary free cortisol, or 1 mg overnight Dexamethasone Suppression Test, am serum Cortisol.

2 Additional: Prolonged Dexamethasone Suppression test, ACTH, Electrolytes, midnight salivary Cortisol. Supplementary: Diagnostic imaging Congenital Adrenal Hyperplasia Baseline: 17-OHP, Electrolytes Additional: Renin Supplementary: Synacthen Stimulation with 17-OHP determination to exclude partial 21-Hydroxylase deficiency Phaeochromocytoma Baseline: Plasma Metanephrines or 24 hour Urinary Fractionated Metanephrines Additional: 24 hour Urinary CatecholaminesALLERGY Baseline: RAST Additional: IgE, FBE, ESRAMENORRHOEA Baseline: HCG, LH, FSH Additional: E2, Prolactin, TFT Supplementary.

3 Cytogenetics, Ovarian-Ab, Urinary Anabolic Steroids, Testosterone, DHEAs, Androstenedione, 17-OHPANAEMIA Macrocytic Baseline: FBE, blood film, ECU, LFT, LDH, B12, Folate, TSH Additional: AIF, PCA, EPG, FLC, Haptoglobin Supplementary: Bone marrow biopsy Microcytic: Baseline: FBE, IS, ECU, LFT Additional: FOB, EPG, Hb-electrophoresis Supplementary: Blood Lead Normocytic: Baseline: FBE, Reticulocyte count, ESR, ECU, CRP Additional: IS, B12, folate, LFT Supplementary: EPG, Bone marrow biopsyANTENATAL testing Note: "Antenatal Screen" is no longer a valid test request. Please specify which of the TESTS below are requested.

4 First visit and < 20 weeks: FBE, ECU, LFT, TFT, Blood group and antibodies, Fasting glucose, Rubella Ab status, Hep B surface Antigen and Hep C antibody, HIV serology, Syphilis serology, Urine MCS, Cervical Cytology Also consider: Maternal antenatal screening (triple test) First Trimester Screen (FTS), or Non-Invasive Pre-Natal test 26 28 weeks: FBE, blood group and antibodies, glucose tolerance test. 30 36 weeks: FBE, Group B Streptococcal vaginal rectal swab for culture Additional: Down syndrome and Neural Tube Defect risk assessment High risk patients: TSH, Thyroid Ab, Vitamin DARTHRITIS Baseline: Rh factor, anti-CCP Ab, ANA, ENA, anti-dsDNA Additional: FBE, ESR, CRP, Synovial fluid examination and biopsy if indicatedBLEEDING DISORDERS Baseline: FBE and film, PTT/INR, APTT, Fibrinogen, TT Additional: Blood: Lupus anticoagulant Serum: Cardiolipin Ab, 2GP1 Supplementary.

5 D-Dimer, Assays for Factor VIIIC, Von Willebrand Disease Screen (VIIIC, VIIIAg, VIIIVWF), Factor IX, Factor XI, XIII and Platelet Aggregation or other Factor Assays, Factor V Leiden, Prothrombin 20210, Protein C and SABThis quick reference GUIDE may be useful in some Clinical situations. The suggested investigations are neither comprehensive nor applicable in all circumstances. TESTS should be selected after consideration of the patient s Clinical history, signs, symptoms and previous test results. For further information, please contact our pathologists, senior scientists or refer to The Royal College of Pathologists of Australia manual at GUIDE TO PATHOLOGY TESTS1300 134 111 | 10/16 P1of4 BONE DISEASE & CALCIUM DISORDERS Baseline: Ca, Mg, PO4, ALP, Vitamin D, PTH Additional: ALP isoenzymes (if ALP elevated), P1NP, CTxBULLOUS SKIN LESIONS Baseline: Swab for MCSCHEST PAIN Baseline: cTn, DDimer Supplementary: CK, CKMBCHRONIC FATIGUE Baseline: FBE, TFT, CRP, ECU, LFT, Cortisol, Glucose (There are no diagnostic TESTS for chronic fatigue syndrome)COELIAC DISEASE Baseline.

6 Transglutaminase Ab, FBE Additional: IgG Antigliadin antibody (in cases of IgA deficiency) Supplementary: Small bowel biopsyDELIRIUM Baseline: FBE, ESR, ECU, LFT, TSH, Glucose, Blood Culture, Urine MCS, CRP Additional: Blood Gas, COHB, Calcium, Salicylate, Lithium, Cortisol CSF: MCS, blood, protein, glucose, immunoglobulins, Urine Drug ScreenDIABETES MELLITUS Baseline: Glucose or HbA1c (high risk, asymptomatic) Monitoring HbA1c, Urine Albumin Additional: GTT Acutely ill: Glucose, ECU, Blood Gas, FBE, Hydroxybutyrate, Lactate, exclude underlying infection, ketonesDIABETES (PREGNANT) GTT (Traditional): 0 min = mmol/L, 2 hour = mmol/L GTT (ADIPS): 0 min = mmol/L, 1 hour > mmol/L, 2 hour > mmol/LDIARRHOEA Laboratory requires Clinical information.

7 Suggested testing : Acute: Baseline: Faeces MCS (1 per 7 days), PCR, OCP Additional: Determined by history Blood Cultures for typhoid, C. difficile toxin testing , viral outbreaks Chronic: Baseline: Faeces MCS, OCP, PCR Additional: Cryptosporidia/Cyclospora stains, Microsporida stain (HIV patients), Sudan black stain for fat globules Supplementary: Disaccharidases and/or Reducing Substances, Lactose Tolerance Test, H Breath Test, Coeliac Screen, Laxative Screen Faecal Na, K, OsmolalityELECTROLYTE DISORDERS Hyperkalaemia Consider spurious result, renal failure, acidosis, adrenocortical insufficiency, drug induced, cellular injury.

8 Baseline: ECU, Glucose, FBE plus platelets Additional: Aldosterone:Renin ratio, random Urine K and Na Hypernatraemia Baseline: ECU Additional: Serum: Osmolality Aldosterone:Renin ratio, ADH Urine: Osmolality, Na, K, Creatinine Hypokalaemia Baseline: ECU, Mg, Glucose. Urine Na, K, Mg Additional: Aldosterone:Renin ratio. 24 hour Urinary Free Cortisol Urine: Na, K, Cl Hyponatraemia Baseline: ECU, glucose, LFT, TSH Additional: TP, Cholesterol plus Triglycerides, Osmolality, Cortisol, ADH. Urine Osmolality, Na, K, CreatinineERECTILE DYSFUNCTION Take the following into consideration when assessing the patient: Assess cardiac risk, diabetes mellitus, testicular failure, drug therapy, post-surgical, prostate radiation, neurological disease, renal failure, psychogenic causes.

9 Baseline: ECU, LH, FSH, Testosterone, Prolactin, GlucoseGENITAL ULCER Baseline: Swabs for PCR (Herpes) and MCS Serum: Syphilis serologyHAEMATURIA Baseline: Urinalysis, MCS and red cell morphology Additional: CytologyHAEMOLYSIS Baseline: FBE, RETC, DAT, ECU, LFT (inc. bilirubin), LDH, Haptoglobin Additional: Cold Haemagglutinines CRP, ANA, DNA, NUCHEPATITIS Baseline: LFT, Urinalysis, FBE, PT Acute: Infectious: Hep A, B, C Alcoholic hepatitis Drugs (Paracetamol, anticonvulsants, NSAIDS, etc.) Hepatic ischemia Chronic: Severity and degree determined on liver biopsy Monitoring: LFTs EPG (helpful in certain cases) Consider Hep B, C, autoimmune hepatitis, alcoholic hepatitis, drugs, Wilson s disease, AAT deficiency, PBC, PSC Granulomatous: Diagnosis requires liver biopsy Causes: Idiopathic, sarcoidosis, drugs (Allopurinol), infective, Hodgkin lymphoma, BerylliosisHEPARIN THERAPY Baseline: APTTHEREDITARY HAEMOCHROMATOSIS Baseline: Iron studies, HFE gene mutations (C282Y, H63D) Additional: HFE mutation S65C, liver biopsyHIRSUTISM Baseline.

10 LH, FSH, E2, Testosterone, SHBG, FAI Additional: 17-OHP, DHEAS, AndrostenedioneHYPERLIPIDAEMIA Baseline: Cholesterol and triglyceride, HDL Additional: HDL, LDL, ECU, TSH, Glucose Supplementary: ApoB, Lp(a), Apo-A, Lipoprotein ElectrophoresisHYPERTENSION Baseline: ECU, urine MCS Additional: TFT, 24 hour Urinary Free Cortisol, Plasma/Urine Metanephrines, Aldosterone:Renin ratioCDEGHJLMNP2of4 GHHYPOGLYCAEMIA Baseline: Glucose, Insulin, C-peptide Additional: Cortisol, Growth Hormone, Proinsulin, Oral Hypoglycaemia Screen, Lactate, HydroxybutyrateIMMUNODEFICIENCY Baseline: FBC, WCC diff, blood film, Ig s (G, A, M), Blood Group, lymphocyte immunophenotyping Additional: IgG subtypes, Neutrophil Function testsINFERTILITY - MALE Baseline: Semen analysis (must reach lab in 2 hours with completed patient information sheet) Additional: LH, FSH, Testosterone, Prolactin, Iron Studies Supplementary: Chromosome studies, Sperm antibodies, Testicular biopsyINFERTILITY - FEMALE Baseline: LH, FSH, day 21 Progesterone, E2 Additional: Prolactin, Testosterone, TFT Supplementary: Chromosome studies, Endometrial biopsy Exclude PID, STIINFLAMMATORY BOWEL DISEASE Baseline.